270 - Associations of Newborn Social Risk Factors with High Infant Weight-for-Length

Publication Number: 270.3681

Carol Duh-Leong, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States; Ivette Partida, Stanford University School of Medicine, Stamford, CT, United States; Morgan Finkel, Columbia University Vagelos College of Physicians and Surgeons, Brooklyn, NY, United States; Melissa S. Stockwell, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Andrew G. Rundle, Mailman School of Public Health, New York, NY, United States; Eliana M. Perrin, Johns Hopkins University Schools of Medicine, Nursing, and Public Health, Baltimore, MD, United States; Erika R.. Cheng, Indiana University School of Medicine, Indianapolis, IN, United States; Dodi Meyer, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Jeff Goldsmith, Columbia University Mailman School of Public Health, New York, NY, United States; Jennifer Woo Baidal, Stanford University School of Medicine, Palo Alto, CA, United States

Background: Socioeconomic disparities in childhood obesity originate early in life. Many health systems are integrating social risk screening into clinical care. Whether social risk factors measured in newborn clinical care are related to later infant weight outcomes is unknown.

Objective: To quantify associations between clinically measured newborn social risk factors and high weight-for-length at infant age 6 months, an established risk factor for childhood obesity.

Design/Methods: This longitudinal, observational study examined electronic health record data among predominantly Medicaid-insured infants at a pediatric primary care network in New York City. Newborn infants with a primary care screening questionnaire for social risks completed between 7/15/2018 and 5/11/2022 were included. Main outcome was high weight-for-length (WFL) measured in routine care, defined two standard deviations or more above the mean by World Health Organization standards. Secondary outcomes were single-timepoint and longitudinal measures of weight outcomes from birth through infant age 6 months. Exposures were food insecurity risk, housing instability, transportation problems, and utility hardship measured using the Hunger Vital Sign (TM) and Accountable Health Communities Screening Tool. Associations of clinically measured newborn social risk factors and infant weight outcomes at age 6 months were examined using unadjusted and adjusted regression analyses. Adjusted models included infant and parent characteristics as covariates.

Results: Among 1,876 newborns, average gestational age was 39.2 weeks, standard deviation [SD] = 1.0), 77.3% identified as Hispanic/Latino, almost all had Medicaid insurance (96.6%). In the newborn period, 355 (23.3%) had food insecurity, 149 (7.9%) had housing instability, 132 (7.0%) had transportation problems, and 110 (5.9%) had utility hardship. Newborns with utility hardship had higher odds of high WFL in unadjusted (OR 3.0, 95% CI: 1.8, 5.2) and adjusted models (aOR 3.1, 95% CI: 1.7, 5.6). Findings were similar for associations of utility hardship with secondary outcomes. Associations were not detected between other newborn social risk factors and infant weight outcomes at 6 months.

Conclusion(s): In this cohort, newborn utility hardship was associated with established obesity risk factors at age 6 months. Interventions to address social risk factors in the newborn period should examine effectiveness of utility shut-off protection to reduce excess infant weight gain.

Figure. Associations between newborn utility hardship and high infant weight-for-length (WFL) at age 6 months among 1,876 infants in a pediatric primary care network in New York City.
LINC 6m PAS abstract_figure.pdfMixed effects logistic regression models. Child-adjusted model adjusted for assigned sex, gestational age at birth, race/ethnicity, precise age at 6-month visit, Medicaid insurance, and birthweight. Parent-adjusted model additionally adjusted the child-adjusted model for birthing parent age, gestational diabetes, and delivery method. Social risk model additionally adjusted the parent-adjusted model for food insecurity, housing instability, transportation problems, and utility hardship. High WFL = Weight-for- Length >97.7th percentile for age and sex on WHO Standards.